From the Guidelines
Diclofenac gel is the preferred choice over etofenamate for topical pain relief due to its more robust clinical evidence and favorable safety profile, as supported by recent studies such as the 2019 update of the EULAR recommendations for the management of hand osteoarthritis 1.
Key Considerations
- Diclofenac gel has been shown to provide small improvements in pain and function after 8 weeks compared to placebo in high-quality studies, with similar pain relief to oral NSAIDs but a more favorable safety profile 1.
- The safety data from randomized clinical trials comparing topical diclofenac gel with placebo in patients with hand and knee OA have demonstrated similar low rates of adverse effects in both low-risk and high-risk patients 1.
- Etofenamate gel, while effective, has fewer large-scale clinical trials supporting its use, making diclofenac gel a more reliable option based on current evidence.
Application and Precautions
- Both diclofenac and etofenamate gels should be applied to clean, dry skin 3-4 times daily, using a thin layer over the affected area without occlusive dressings.
- Patients should be aware of potential side effects, including local skin reactions like redness or itching, and avoid using these medications on broken skin or exposed to sunlight.
- Individuals with aspirin allergies, severe asthma, or in the third trimester of pregnancy should avoid both medications.
Evidence Summary
- The 2019 EULAR recommendations 1 and other studies, such as those on diclofenac gel for actinic keratosis 1, support the efficacy and safety of diclofenac gel for topical pain relief, making it the preferred choice over etofenamate based on the strength and recency of the evidence.
From the Research
Comparison of Etofenamate and Diclofenac Gel
- There are no direct studies comparing etofenamate and diclofenac gel in the provided evidence.
- However, the studies suggest that diclofenac gel is an effective and well-tolerated treatment for osteoarthritis, with fewer systemic adverse events compared to oral NSAIDs 2, 3, 4, 5.
- The efficacy of diclofenac gel has been demonstrated in various studies, including a narrative review that found it to be a guideline-supported, generally well-tolerated, and effective first-line treatment option for knee and hand OA 2.
- Another study found that diclofenac gel provided significant improvements in pain and function in both younger and older patients with knee osteoarthritis, with a good safety and tolerability profile 4.
- A randomized controlled trial also found that diclofenac gel was effective and well-tolerated in patients with knee osteoarthritis, with significant reductions in pain and improvement in physical function 5.
- A narrative review comparing oral and topical diclofenac sodium found that the topical solution had a better tolerability profile, especially in patients with a history of potential risk and adverse side effects 6.
Efficacy and Safety of Diclofenac Gel
- Diclofenac gel has been shown to be effective in reducing pain and improving physical function in patients with osteoarthritis 2, 4, 5.
- The safety profile of diclofenac gel is generally good, with fewer systemic adverse events compared to oral NSAIDs 2, 3, 4, 5.
- The most common adverse event associated with diclofenac gel is application site dermatitis 4, 5.